| NPI | 1861590473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 1781) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 41842) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-12-31 |