| NPI | 1508197740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM I-0947) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-0947) |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2010-02-02 |