| NPI | 1952047011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 16694) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 106890) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2022-05-10 |