| NPI | 1285997833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 7222) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C009183) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50079509) | |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW005370) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2015-01-12 |