| NPI | 1760091664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015793) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 12148) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2025-10-13 |