| NPI | 1710644976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 11972-123) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2025-09-12 |