| NPI | 1306017132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2007007210) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY 360) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2008-03-19 |