| NPI | 1700279585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C8459) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MS M8459) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2018-10-17 |