| NPI | 1861852212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 26866) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: VA 0904009541) |
| 1041C0700X Social Worker Clinical (Licence: MD 21841) | |
| 1041C0700X Social Worker Clinical (Licence: DC LC50080956) | |
| Enumeration Date | 2016-02-27 |
| Last Update Date | 2021-06-02 |