| NPI | 1073507042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C004778) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL SW6111) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2007-10-09 |