| NPI | 1881611564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 000877) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS 1151) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-12-08 |