| NPI | 1679526362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 3810) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SD 188) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2010-10-21 |