| NPI | 1215194121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-38761) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 70059863502) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2021-03-17 |