| NPI | 1801331640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 010494) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 3249) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2019-05-06 |