| NPI | 1851542864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 4131-123) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: WI 050912) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2008-10-08 |