| NPI | 1083019913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 12619) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2013035402) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2022-08-01 |