| NPI | 1013215201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 5572) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW16165) |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2024-03-15 |