| NPI | 1508894056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 2215) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC LISW-CP #2215) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-04-27 |