| NPI | 1306290556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: IA 05641) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 05641) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2016-04-13 |