| NPI | 1558740076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 3012) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW 10088) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2015-05-29 |