| NPI | 1033161690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MT LCSW#5) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT 00005) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2010-09-30 |