| NPI | 1245516327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 11281) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ 12224) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2011-11-02 |