| NPI | 1023221967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2020023042) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW9297) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50081569) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2022-02-24 |