| NPI | 1356681969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 1420) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 4214) |
| 104100000X Social Worker (Licence: NE 1491) | |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2015-07-01 |