| NPI | 1104855527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 1680-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 004386) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-07-08 |