| NPI | 1831524537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 4611) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 41156) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2023-07-13 |