| NPI | 1992441968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L15377) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 2807733501) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2026-02-24 |