| NPI | 1932926615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC P020581) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NC 9409) |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2024-12-04 |