| NPI | 1639899818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 20579) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 79760) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2022-08-30 |