| NPI | 1962634436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 84160223501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC13359) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2014-05-08 |