| NPI | 1215362256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00944286) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WV BP00944286) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2018-09-19 |