| NPI | 1770863847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2010024609) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW7538) |
| 1041C0700X Social Worker, Clinical (Licence: NY 021637) | |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2011-09-22 |