| NPI | 1477886760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-07206) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM X-06780) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2010-02-16 |