| NPI | 1568490498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW004156) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA LISW #02931) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2013-03-20 |