| NPI | 1699860890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 2728) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 2728123) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2018-10-02 |