| NPI | 1194128322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C2599) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AR 1787-C) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2014-10-02 |