| NPI | 1538146204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO LCSW 005964) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS LSCSW 1757) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2009-08-27 |