| NPI | 1518950450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 24) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 31) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2010-07-23 |