| NPI | 1275004012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 011113) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 4440) |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2020-09-25 |