| NPI | 1528264983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904007611) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: GA CSW003967) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2012-02-24 |