| NPI | 1245209329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2004024505) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AR 2042-C) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2015-03-13 |