| NPI | 1396829164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C008655) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904003021) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2016-05-12 |