| NPI | 1770945255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2013018608) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS 4184) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2016-03-24 |