| NPI | 1578686663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C012820) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 12008) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2021-10-25 |