| NPI | 1043368186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09923286) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 27843) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2013-10-28 |