| NPI | 1992034672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NE 1041) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NE 2406) |
| 1041C0700X Social Worker Clinical (Licence: NE 2406) | |
| 1041C0700X Social Worker Clinical (Licence: NE 1041) | |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2022-02-16 |