| NPI | 1578840005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 5962187-3501) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NV 5955-C) |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2022-10-06 |