| NPI | 1962437988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OR L4306) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2017-03-09 |