| NPI | 1588716039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 362016-3501) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 17133) |
| 1041C0700X Social Worker Clinical (Licence: IA 06455) | |
| 1041C0700X Social Worker Clinical (Licence: ND 3846) | |
| 1041C0700X Social Worker Clinical (Licence: SD 2038) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2009-09-03 |