| NPI | 1144625088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041S0200X Social Worker School (Licence: DC LC50081548) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 19891) |
| 1041C0700X Social Worker Clinical (Licence: DC LC50081548) | |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2018-08-08 |