| NPI | 1740337922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50077705) |
| Additional Taxonomies | 174400000X Specialist (Licence: DC 501982) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2011-06-20 |