| NPI | 1154712107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW36510) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 34439) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2017-04-25 |