| NPI | 1437120227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904013038) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 0872) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2021-12-03 |