| NPI | 1578230165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9594) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 25387) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2022-06-23 |