| NPI | 1437584125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6113) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 29871) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2014-09-16 |