| NPI | 1871767095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C007445) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 6254) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2019-12-31 |