| NPI | 1184816571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09924816) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 3107) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2017-07-24 |