| NPI | 1922792696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-38035) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 38035) |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2024-08-08 |