| NPI | 1982884912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6433) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 324492-3051) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2024-12-22 |