| NPI | 1073108940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 11572) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 4649) |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2021-09-20 |