| NPI | 1467475921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 15844) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 1894) |
| 1041C0700X Social Worker, Clinical (Licence: MS CO432) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2011-08-23 |