| NPI | 1194153429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 6605) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.00992346) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2019-05-20 |