| NPI | 1982299590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 005770) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 105291) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09930701) | |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2026-03-24 |