| NPI | 1376619619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID LCSW-30327) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OR 018133) |
| 1041C0700X Social Worker Clinical (Licence: NM X-05916) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2010-05-03 |