| NPI | 1124359682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 4724) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2010-01-23 |
| Last Update Date | 2015-01-29 |