| NPI | 1275847337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MS C6918) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TN 4333) |
| Enumeration Date | 2010-07-31 |
| Last Update Date | 2010-08-30 |