| NPI | 1063564516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN 5575) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 113374) |
| 1041C0700X Social Worker Clinical (Licence: 211886) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2012-04-28 |