| NPI | 1750769725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC LISWCP15870) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW006851) | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2026-04-06 |