| NPI | 1194015487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 05104) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: DC LC301984) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2011-04-08 |