| NPI | 1669657425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 404) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 122705-3502) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2007-12-28 |