| NPI | 1801446117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 06271) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2025032794) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2025-11-21 |