| NPI | 1528481900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN LSW0000007073) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C009975) |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2025-02-24 |