| NPI | 1689898512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2005035889) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS 3608) |
| 1041C0700X Social Worker Clinical (Licence: NE 939) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-08 |