| NPI | 1659655678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC c004621) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 1616c) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2021-04-19 |