| NPI | 1003161597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW 27347) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 1763) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2018-12-03 |