| NPI | 1609435817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C013980) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P013467) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2021-08-02 |