| NPI | 1912172826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 2166C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW 4889) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2016-07-21 |