| NPI | 1851451157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 3719) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 4957-C) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2022-10-26 |