| NPI | 1225571763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 9927031) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 58.009647) |
| Enumeration Date | 2016-12-01 |
| Last Update Date | 2022-10-19 |