| NPI | 1215388814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P010476) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NC 1199035) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2016-07-13 |