| NPI | 1164445581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 9037) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MO 2002025562) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-12-13 |