| NPI | 1588063929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2016003045) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 9318) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2016-10-12 |