| NPI | 1083882971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO SW001993) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SW001993) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2011-03-16 |