| NPI | 1124055843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TN 0387) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TN 0387) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2009-10-23 |