| NPI | 1992108658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C012882) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P011176) |
| 1041C0700X Social Worker, Clinical (Licence: KY 254677) | |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2020-11-30 |