| NPI | 1932724960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: 33128) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT 33128) |
| 251E00000X Home Health | |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2023-04-19 |