| NPI | 1992199723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 111212) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AK 124965) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2025-05-23 |