| NPI | 1710082706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 890) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW8008) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2010-02-01 |