| NPI | 1750589289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 14571) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0000886) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2014-07-25 |