| NPI | 1467829390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MT SWP-LCSW-LIC-12360) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2024-11-20 |