| NPI | 1649518440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 1255) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 7369215-3501) |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2014-05-08 |