| NPI | 1154435790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW004019) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW003109) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2013-11-08 |