| NPI | 1689644890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WV CP00450557) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904000883) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2007-07-08 |