| NPI | 1477859262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4555) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 8392) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2016-12-09 |