| NPI | 1952162158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PR 17117) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PR 26206) |
| Enumeration Date | 2024-01-16 |
| Last Update Date | 2025-02-19 |