| NPI | 1285629378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MD 2805) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MD LCSWC2805) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2015-11-24 |