| NPI | 1306878376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 16733) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 1017034) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-03-06 |