| NPI | 1861472276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: 14602) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 14602) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2009-04-20 |