| NPI | 1407157407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 2160C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW003706) |
| 1041C0700X Social Worker, Clinical (Licence: UT 5411455-3501) | |
| Enumeration Date | 2010-11-06 |
| Last Update Date | 2010-11-06 |