| NPI | 1467759670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 9572110-3502) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 9572110-3503) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2020-09-02 |