| NPI | 1528428554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L8010) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 4971566-3501) |
| 1041C0700X Social Worker, Clinical (Licence: ID LCSW-34389) | |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2020-05-14 |