| NPI | 1710172457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2010038259) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 13115) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2011-03-01 |