| NPI | 1528477650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C009725) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: CO NLC.0103764) |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2015-10-21 |