| NPI | 1467607259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8283-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 006564) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2018-06-27 |