| NPI | 1740508688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI 3637) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 73-069952) |
| 1041C0700X Social Worker, Clinical (Licence: AZ 11892) | |
| Enumeration Date | 2010-05-15 |
| Last Update Date | 2011-05-18 |