| NPI | 1851697635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MS C8764) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: LA 8842) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2020-09-18 |