| NPI | 1386630275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MT 700LCSW) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 19449) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2007-07-08 |