| NPI | 1245574821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 92643) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 104856) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50079618) | |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2024-06-28 |