| NPI | 1821557646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-4657) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2022-05-22 |