| NPI | 1851400790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2013010964) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 1928) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-05-08 |