| NPI | 1831807049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 13104027-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC200002029) |
| Enumeration Date | 2022-11-08 |
| Last Update Date | 2023-06-15 |