| NPI | 1053571802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09925912) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 4218) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2019-09-25 |