| NPI | 1780694604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 6008) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 3730) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2007-07-08 |