| NPI | 1093830192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ 12435) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: GA CSW003472) |
| 1041C0700X Social Worker Clinical (Licence: TN LSW0000004703) | |
| 1041C0700X Social Worker Clinical (Licence: AL 1959C) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2009-09-16 |