| NPI | 1588082515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV BP00944163) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WV BP00944163) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2018-04-05 |