| NPI | 1679080360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-11693) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 130589-121) |
| 1041C0700X Social Worker, Clinical (Licence: WI 9370-123) | |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2024-07-21 |