| NPI | 1811362155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 15344) |
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 15344) |
| Enumeration Date | 2015-12-12 |
| Last Update Date | 2024-05-15 |