| NPI | 1134208598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 001080) |
| Additional Taxonomies | 273R00000X Psychiatric Unit (Licence: CT 001080) |
| Enumeration Date | 2006-11-04 |
| Last Update Date | 2013-08-05 |