| NPI | 1710072178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 2740) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MS C8179) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-12-02 |