| NPI | 1174766448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID LCSW-32181) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-29004) |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2018-11-14 |