| NPI | 1881995421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 16860) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 14910292) |
| Enumeration Date | 2010-11-13 |
| Last Update Date | 2019-12-31 |