| NPI | 1174600944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 9944-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 8502) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-07-26 |