| NPI | 1710148036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-07388) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM X-06212) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2014-07-09 |