| NPI | 1922197474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 2389) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904002903) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |