| NPI | 1356651186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P009057) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2014-10-31 |