| NPI | 1518427319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 11548679-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 11548679-3502) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2022-09-29 |