| NPI | 1730376369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 7730) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW10640) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2012-10-24 |