| NPI | 1295938983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 004639) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS 1682) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2007-07-08 |