| NPI | 1821584335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C013691) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P012578) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2025-06-16 |