| NPI | 1306248117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C010294) |
| Additional Taxonomies | 251S00000X (Licence: NC P008870) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2022-07-21 |