| NPI | 1699118935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6545) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OR A3225) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2015-11-18 |