| NPI | 1619773058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 13098-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 135353-121) |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2026-07-28 |