| NPI | 1114544616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW3075) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK LCSW6946) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2020-06-30 |