| NPI | 1154636603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60218364) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 081733) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2015-07-10 |