| NPI | 1629068622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-1205) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 8830-123) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2019-09-10 |