| NPI | 1285963223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID LCSW -30112) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: ID LCSW30122) |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2020-03-03 |