| NPI | 1447578356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09923019) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 53093) |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2018-08-21 |