| NPI | 1184660425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW005276) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 5382231-3501) |
| 1041C0700X Social Worker, Clinical (Licence: AL 3718C) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2014-11-10 |