| NPI | 1750608337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C008005) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 10267) |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2015-04-10 |