| NPI | 1114481397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2011008912) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 16252) |
| 1041C0700X Social Worker, Clinical (Licence: AL 4838C) | |
| 1041C0700X Social Worker, Clinical (Licence: WI 8370-123) | |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50080815) | |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2024-05-11 |