| NPI | 1821433491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC CO13376) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149015355) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09923224) | |
| 1041C0700X Social Worker, Clinical (Licence: FL SW15740) | |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2021-07-15 |