| NPI | 1700189594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 379649-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 3796493502) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2012-02-29 |