| NPI | 1962545624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 806) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2018-03-16 |