| NPI | 1407952278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 3737) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 4738) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2016-06-15 |