| NPI | 1942677901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA 005953) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 726) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2019-04-17 |