| NPI | 1396723912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 005044) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 005044) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2014-02-24 |