| NPI | 1952170037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 5576C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 8301) |
| Enumeration Date | 2023-12-29 |
| Last Update Date | 2024-05-08 |