| NPI | 1124144183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 13442) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 23184) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2024-04-25 |