| NPI | 1700961976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C6761) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 2249C) |
| 163W00000X Registered Nurse (Licence: MS R894867) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2013-08-06 |