| NPI | 1417984436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2004016349) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 2473) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2007-07-08 |