| NPI | 1194187898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-38192) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-34845) |
| 1041S0200X Social Worker, School (Licence: ID LMSW-34845) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2023-02-08 |