| NPI | 1407124217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 17447) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: DC LC50081219) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2025-02-20 |