| NPI | 1609005446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW005575) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 11196) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2016-01-05 |