| NPI | 1891334025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 15281) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 12416) |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2023-05-22 |