| NPI | 1174525190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: SD LCSW-PIP #947) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA LISW#06042) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2016-09-14 |