| NPI | 1871809400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 992658) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ 20658) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2025-06-02 |