| NPI | 1366575045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C004703) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 8663) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2009-05-12 |