| NPI | 1851942999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 15647) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P013957) |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2026-04-28 |