| NPI | 1508991829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005677) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P002798) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2021-12-27 |