| NPI | 1215098561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW2031) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC5681) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2012-08-31 |