| NPI | 1689852261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09923090) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA A5232512) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2013-09-11 |