| NPI | 1902924830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 000182) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC 3000072) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2008-08-08 |