| NPI | 1316953540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 885-123) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 885-123) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-05-21 |