| NPI | 1598014193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009021) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NC P007540) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2016-09-21 |