| NPI | 1407078603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW004391) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 55815) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2015-02-20 |