| NPI | 1669788105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR A6052) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR M6052) |
| Enumeration Date | 2010-08-22 |
| Last Update Date | 2015-05-10 |