| NPI | 1225340912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KS 4374) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS 7784) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2014-10-27 |