| NPI | 1073858411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34006617A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 3705) |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2012-12-11 |