| NPI | 1194022293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW007658) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-17112) |
| 1041C0700X Social Worker, Clinical (Licence: NY R079976) | |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2022-03-09 |