| NPI | 1609011600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C007079) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AR 2044-C) |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2021-05-17 |