| NPI | 1023022126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C013481) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2009006272) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-05-01 |