| NPI | 1417352329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C010562) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P009153) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2020-07-08 |