| NPI | 1376662304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2009025847) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AR 2366-C) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2017-04-20 |