| NPI | 1154509123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC DC LC303654) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 11950) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2017-11-09 |