| NPI | 1063655249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 6302895-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 8713) |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2015-08-17 |