| NPI | 1861762536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C008276) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P005786) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2013-07-24 |