| NPI | 1659868693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 10220-123) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2023-09-11 |