| NPI | 1609124718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4318) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2011025106) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2023-03-02 |