| NPI | 1174876460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL ISW6990) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN LSW8461) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2023-09-07 |