| NPI | 1649783663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 4393C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 23302) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2020-06-05 |