| NPI | 1164518668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 09463) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DE Q10000744) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2016-10-18 |