| NPI | 1114300647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 10254) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0001639) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2018-12-02 |