| NPI | 1154405389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 076639) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: HI 3200) |
| 1041C0700X Social Worker Clinical (Licence: GA CSW008182) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2023-04-11 |