| NPI | 1770897175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C008115) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P005914) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2016-02-29 |