| NPI | 1336167261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-29633) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-27457) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2013-06-19 |