| NPI | 1609812072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 2023) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 005929) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2023-03-23 |