| NPI | 1205013570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 6403-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 5345-S) |
| 1041C0700X Social Worker, Clinical (Licence: NV IC-581) | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2015-04-02 |