| NPI | 1558349878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO LCSW-005366) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS LSCSW-1712) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2012-12-07 |