| NPI | 1275853103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C004437) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 7329) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2022-03-30 |