| NPI | 1386201861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 87999) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149020632) |
| 1041C0700X Social Worker, Clinical (Licence: WI 11907-123) | |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2024-09-03 |