| NPI | 1467746461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904006140) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 037697-1) |
| 104100000X Social Worker (Licence: MN 12102) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2014-02-06 |