| NPI | 1588793012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV #5778-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AK #992) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2011-07-07 |