| NPI | 1386832574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 10698) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AR 1314C) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2023-10-10 |