| NPI | 1558409060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-08163) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2003015888) |
| 1041C0700X Social Worker, Clinical (Licence: MO 2003015888) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2013-05-17 |