| NPI | 1770524936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: KS LSCSW2212) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO LCSW000213) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2010-08-12 |