| NPI | 1386088086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009313) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 11123) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2015-05-26 |