| NPI | 1215160403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 3367) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 1086) |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2009-11-11 |