| NPI | 1487825261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: SD 5004) |
| 104100000X Social Worker (Licence: SD 4732) | |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2023-07-24 |