| NPI | 1700233269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8930-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.014664) |
| Enumeration Date | 2016-05-15 |
| Last Update Date | 2023-04-07 |