| NPI | 1568579829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 3107-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 403-125) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |