| NPI | 1356329452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: GA 000692) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WY LCSW 499) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2007-07-08 |