| NPI | 1003972696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7736-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 127170) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2012-06-05 |