| NPI | 1023358900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: SC 11162) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC P007192) |
| Enumeration Date | 2013-02-28 |
| Last Update Date | 2015-08-17 |