| NPI | 1144769522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SD 1450) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ND 3228) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2017-02-17 |