| NPI | 1518209527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2015010637) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 61564) |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2018-03-18 |