| NPI | 1013345578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C008817) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 116216) |
| Enumeration Date | 2013-10-21 |
| Last Update Date | 2014-06-03 |