| NPI | 1992109375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT SWP-LCSW-LIC-8615) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT 8615) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2022-02-10 |