| NPI | 1992865307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 1241) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 006065) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2016-10-12 |