| NPI | 1003586710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0000564) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 12735) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2022-01-13 |