| NPI | 1598803900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW3458) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW123743) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2010-01-27 |