| NPI | 1962939504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 9166-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 130401-121) |
| 1041C0700X Social Worker Clinical (Licence: NV 12322-C) | |
| Enumeration Date | 2017-05-14 |
| Last Update Date | 2025-05-21 |