| NPI | 1700865631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: SC 9670) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WV BP00942283) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2015-01-16 |