| NPI | 1063829901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 1211) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.00991938) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2019-07-19 |