| NPI | 1659984755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 11876-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 11065-120) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2024-09-27 |