| NPI | 1891995734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-06713) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-06713) |
| 1041C0700X Social Worker, Clinical (Licence: NM 06020) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2016-04-20 |