| NPI | 1215186234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C15345) |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker (Licence: MI 390200000X) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149015882) | |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2023-12-26 |