| NPI | 1689176018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 23190) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: DC LC50080437) |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2024-06-10 |