| NPI | 1639403132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: NC C008532) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801091106) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW13009) | |
| 1041C0700X Social Worker, Clinical (Licence: SC 12162) | |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2025-01-24 |