| NPI | 1881098176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC20001422) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 55822) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2022-03-31 |