| NPI | 1760784714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MS m6940) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 13168) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2023-09-11 |