| NPI | 1457425449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AR 1895-C) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: AR 4196-C) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2018-05-14 |