| NPI | 1427194299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 001056) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO SW001056) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2024-01-12 |