| NPI | 1255494555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-28951) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT 574) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2022-04-05 |