| NPI | 1871789511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 5752) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 12712) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2022-04-04 |