| NPI | 1821640640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NV 12547-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 12547-C) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2026-04-04 |