| NPI | 1336267285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L4659) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ 12741) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2017-02-20 |