| NPI | 1750521837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005906A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 992328) |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2011-09-13 |