| NPI | 1841511540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 41536) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 6606786-3501) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2025-01-30 |