| NPI | 1558715979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC CO14124) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 097284) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2023-10-16 |