| NPI | 1376162024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PR 15286) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PR 24478) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2020-09-15 |