| NPI | 1295838555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61350720) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.011991) |
| 1041S0200X Social Worker, School (Licence: IL 1935083) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2024-03-23 |