| NPI | 1639367006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 5316-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI 3443) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2019-05-10 |