| NPI | 1649940461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NC P016761) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NC P016761) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2025-05-08 |