| NPI | 1700140472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NE 1595) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IA 000397) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2012-06-27 |