| NPI | 1497094882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 3776C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AL 2962G) |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2020-08-01 |