| NPI | 1306132493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW - 34818) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-31474) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2015-06-17 |