| NPI | 1649556663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C008664) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P-006939) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2015-07-24 |