| NPI | 1376090480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C012229) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC P010853) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2022-11-10 |