| NPI | 1790935591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 2278-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2008027935) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2011-03-21 |