| NPI | 1114141520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6895) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L6138) |
| 1041C0700X Social Worker, Clinical (Licence: NM I-06318) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2022-05-02 |