| NPI | 1902166101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 4920) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OK 4323) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2016-05-25 |