| NPI | 1285042762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50082423) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 58760) |
| 104100000X Social Worker (Licence: NM X-086000) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149.017156) | |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2020-04-22 |