| NPI | 1992800775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 2198-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 152227) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2025-07-11 |