| NPI | 1528270055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 000308) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 0902) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2012-02-22 |