| NPI | 1679847065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI 3517) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 214) |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2012-03-01 |