| NPI | 1164813135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: C013499) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P012561) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2023-11-02 |