| NPI | 1154710960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006155) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW006625) |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2023-04-11 |