| NPI | 1285905802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 1003) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA 1659) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2013-01-28 |