| NPI | 1861833857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 086388) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: GA CSW006817) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2021-07-07 |