| NPI | 1568644516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 171W00000X Contractor |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| Enumeration Date | 2007-12-02 |
| Last Update Date | 2018-11-07 |