| NPI | 1578301313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2024-07-16 |
| Last Update Date | 2024-07-16 |