| NPI | 1306279559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM X-10430) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM M-07770) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2018-04-13 |