| NPI | 1508850215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN 4506) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KY 1765) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2007-07-08 |