| NPI | 1154772689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 8044-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AR 8044-M) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2018-12-14 |