| NPI | 1972863967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 58.009695) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 66449) |
| 1041C0700X Social Worker Clinical (Licence: SC 12689) | |
| 1041C0700X Social Worker Clinical (Licence: NC C010755) | |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2021-10-28 |