| NPI | 1669062576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC200003344) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 12093-123) |
| Enumeration Date | 2021-01-25 |
| Last Update Date | 2025-10-16 |