| NPI | 1962939629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 7999048-3501) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2022-06-28 |