| NPI | 1285871574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904007991) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 004995) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2016-06-06 |