| NPI | 1295953818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005948) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 9829) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2011-07-19 |