| NPI | 1629174438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 992544) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 077486-1) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05079100) | |
| 1041C0700X Social Worker, Clinical (Licence: PA CW015444) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2021-04-19 |