| NPI | 1033111398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005505) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904002496) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2007-07-08 |