| NPI | 1306109178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C010367) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P010011) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2017-03-06 |