| NPI | 1508028473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7164800-3501) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2016-04-11 |