| NPI | 1730103375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34007176A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2004024418) |
| 1041C0700X Social Worker, Clinical (Licence: TX 50540) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2016-09-08 |