| NPI | 1275546376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: LA CMSW3490) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN CMSW6939) |
| 1041C0700X Social Worker, Clinical (Licence: TN CMSW6939) | |
| 1041C0700X Social Worker, Clinical (Licence: LA CMSW3490) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2007-07-08 |