| NPI | 1285693200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 002203) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 1591) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2020-10-09 |