| NPI | 1164824934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 7169-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AR 7169-M) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2017-06-30 |