| NPI | 1447373881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM I-06657) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 34896) |
| 1041C0700X Social Worker Clinical (Licence: IN 34005492A) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2009-10-20 |