| NPI | 1588171557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 14211) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC sw.11798) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2025-05-01 |