| NPI | 1588986723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1140189) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PR 10248) |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2025-08-08 |