| NPI | 1861825804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 9643722-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-30399) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2023-03-07 |