| NPI | 1871997379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 120381) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA 61312959) |
| 1041C0700X Social Worker, Clinical (Licence: NH 2094) | |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2024-11-22 |