| NPI | 1942961867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AL 5368G) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: AL 5668G) |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2022-01-04 |