| NPI | 1265914428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 9510-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 131117) |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2021-08-06 |