| NPI | 1821307828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904002971) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY PR014348-1) |
| 1041C0700X Social Worker Clinical (Licence: FL SW3531) | |
| Enumeration Date | 2010-09-26 |
| Last Update Date | 2017-12-08 |