| NPI | 1801848114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 2455123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 1783) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-07-08 |