| NPI | 1225142573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IA 007212) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MO 2005033793) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2009-04-06 |