| NPI | 1104013259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OR L5986) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: HI LCSW 3436) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2018-09-20 |