| NPI | 1821410580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 12555) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-08080) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-01-15 |