| NPI | 1144331489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS LSCSW1549) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 1549) |
| 1041C0700X Social Worker, Clinical (Licence: MO LCSW2000170898) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-05-29 |