| NPI | 1083913222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5483308-3501) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: UT 5483308-3502) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2016-07-28 |