| NPI | 1871745281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY 667) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 1496) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2025-08-28 |