| NPI | 1053677153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8790) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 19608) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2019-05-13 |