| NPI | 1194193623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ND 6226) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IN 34006131A) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2022-03-13 |