| NPI | 1912546854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015488) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P011678) |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2022-12-28 |