| NPI | 1477848265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009001) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P007343) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2014-07-30 |