| NPI | 1871197319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 14453) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 4818) |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2024-09-23 |