| NPI | 1750618336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4352) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2015021883) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2018-02-22 |