| NPI | 1730414053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NC 717C23) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC 717C23) |
| 251S00000X Community/Behavioral Health (Licence: NC 717C23) | |
| Enumeration Date | 2009-10-04 |
| Last Update Date | 2024-01-18 |