| NPI | 1114270998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 2376C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 7818) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2023-12-06 |