| NPI | 1194964643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 6221752-3501) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: UT 62217523502) |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2015-08-12 |