| NPI | 1295809432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 3196) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN LSW3196) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2018-05-08 |