| NPI | 1578732350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7991-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 18841) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2024-03-04 |