| NPI | 1437337714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 904006767) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0904006767) |
| 104100000X Social Worker (Licence: VA 0904006767) | |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2009-09-15 |