| NPI | 1548437403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 814) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM X-06197) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2011-03-31 |