| NPI | 1528218328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2007033658) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2008004864) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2014-07-08 |