| NPI | 1407089865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM 1-07247) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM X-06729) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2014-03-06 |