| NPI | 1851198683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 14282246-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO Lsw.0009925438) |
| Enumeration Date | 2025-02-28 |
| Last Update Date | 2026-04-16 |