| NPI | 1598713265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 4640126C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL PIP 464 0126C) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2008-12-29 |