| NPI | 1528098951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 07129) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C004311) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2015-08-18 |