| NPI | 1629218748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4948) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2011035518) |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2019-06-05 |