| NPI | 1922751585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC200003868) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DC LG200001451) |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2025-08-19 |