| NPI | 1598015729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C010451) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 12296) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2023-01-20 |