| NPI | 1962542027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN 4823) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC 005475) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |