| NPI | 1730120478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801084709) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33002131A) |
| 1041C0700X Social Worker Clinical (Licence: IN 34003388A) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2024-02-08 |