| NPI | 1952320566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY PR032920) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34004228A) |
| 1041C0700X Social Worker, Clinical (Licence: OH I8680) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2011-07-06 |