| NPI | 1245332188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 9003) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW003365) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-03-13 |