| NPI | 1528286143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L3946) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR 3946) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2015-10-05 |