| NPI | 1063894186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 22248) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PR 19379) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2024-07-08 |