| NPI | 1659365039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2004031337) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-25690) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2008-02-11 |