| NPI | 1598191546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P006940) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC 3507-A) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2013-09-23 |