| NPI | 1700037652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7082877-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 7082877-3502) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2018-12-10 |