| NPI | 1093803314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM X-07673) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 1544) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2012-03-27 |