| NPI | 1730841339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2021012425) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 05488) |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2021-10-11 |