| NPI | 1568675551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 11609) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 11609) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW7340) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2019-02-12 |