| NPI | 1093843864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 3502) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 0046C) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2007-07-09 |