| NPI | 1952607764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 9033549-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2015019298) |
| 1041C0700X Social Worker, Clinical (Licence: NY 082270) | |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2023-07-21 |