| NPI | 1104846310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 1878) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 1878B) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2008-06-10 |