| NPI | 1588891485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NE 8793) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NE 6663) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2009-06-18 |