| NPI | 1821413816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 26752) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 29505) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06224900) | |
| 1041C0700X Social Worker, Clinical (Licence: FL 21743) | |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2023-07-19 |