| NPI | 1841623840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 8146-123) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 8146) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2021-06-02 |