| NPI | 1275696882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2004019056) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 2399) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2007-07-08 |