| NPI | 1629131388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CT 000631) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 000631) |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2018-05-01 |