| NPI | 1134299613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-3048) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 4948-C) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-09 |