| NPI | 1336329275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 006587) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: CT 006587) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2010-04-13 |