| NPI | 1700289659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 11319) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MS m8127) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2019-01-23 |