| NPI | 1194127837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009064) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 13270) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149016789) | |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2025-01-11 |