| NPI | 1063555308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6466) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 05-03-03) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2019-04-08 |