| NPI | 1831543719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: DC LC50080816) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MD 18972) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2023-07-05 |