| NPI | 1588984637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WY 812) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WY 414) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2020-09-08 |