| NPI | 1164443800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW8499) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IN 34002831A) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2018-09-04 |