| NPI | 1285754473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 54011) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I 0900125) |
| 1041C0700X Social Worker, Clinical (Licence: LA 8755) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2010-06-30 |