| NPI | 1154551422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2002030046) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ 12469) |
| 1041C0700X Social Worker, Clinical (Licence: CO 125) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2009-07-21 |