| NPI | 1043399116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY 392) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 18753) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2011-04-15 |