| NPI | 1194128504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 005605) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS 2168) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2022-11-08 |