| NPI | 1629346143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW09923052) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 999) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2012-10-16 |