| NPI | 1801347232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 9854) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 9845) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2023-09-19 |