| NPI | 1629480868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ND 7168) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW15980) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2026-08-17 |