| NPI | 1982681037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C004566) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904004855) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2010-11-08 |