| NPI | 1619192382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005594) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 5954) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2011-12-29 |