| NPI | 1518185966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 007373) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2010-08-19 |