| NPI | 1700101920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 6206-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT 862-LCSW) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2021-05-06 |