| NPI | 1851779680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AR 8052-C) |
| Additional Taxonomies | 1041S0200X Social Worker School |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2021-10-25 |