| NPI | 1427455823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MT SWP-LCSW-LIC-9659) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: UT 7891864-3501) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-17 |