| NPI | 1689244113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015963) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 30566) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2024-07-13 |