| NPI | 1609008374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 3184) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW003544) |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2009-08-14 |