| NPI | 1295776698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 07578) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 992792) |
| 104100000X Social Worker (Licence: MD 07578) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2016-01-12 |