| NPI | 1518013168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7039) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 115635) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2021-02-02 |