| NPI | 1750792800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C011345) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC P008656) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2022-10-24 |