| NPI | 1407063191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA SSW002561) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL SW6496) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2007-09-26 |