| NPI | 1699088492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 852) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: CO 0467510) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2010-07-21 |