| NPI | 1396282984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NV IC-944) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 6938-S) |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2017-05-05 |