| NPI | 1063536977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: SD 2252) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 34297) |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2007-07-08 |