| NPI | 1255340832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 1656) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2017-08-28 |