| NPI | 1780742882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 6755) |
| Additional Taxonomies | 104100000X Social Worker (Licence: 6755) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2021-06-02 |