| NPI | 1689016065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 3749) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MS C5773) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2013-07-25 |