| NPI | 1700834090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904007713) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IN 34004052) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2013-06-06 |