| NPI | 1023023454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA CSW004063) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MS C5474) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-02-08 |