| NPI | 1730129370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 17325) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD G12151) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2017-11-15 |