| NPI | 1811433147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 4328C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 3997G) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2022-10-11 |