| NPI | 1861906497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L8362) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR A4653) |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2022-12-07 |