| NPI | 1235425745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NV 6348-C) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NV 5806S) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2015-07-14 |