| NPI | 1225431935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 56863) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW006098) |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2014-10-08 |