| NPI | 1336293836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW0004306) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN SW00296) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2014-09-29 |