| NPI | 1831152891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 1440) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 8054443-3501) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2011-10-06 |