| NPI | 1750652269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C008920) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 084072) |
| Enumeration Date | 2012-01-16 |
| Last Update Date | 2020-01-07 |