| NPI | 1770510653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN 0000595) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: VA 0904002972) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2007-07-08 |