| NPI | 1396781951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2009014953) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AR 1827-M) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-03-24 |