| NPI | 1609925460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 26926) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 5332461-3501) |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW003889) | |
| 1041C0700X Social Worker, Clinical (Licence: TN LSW0000004932) | |
| 1041C0700X Social Worker, Clinical (Licence: AL 2114C) | |
| 1041C0700X Social Worker, Clinical (Licence: MS C7426) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2010-01-29 |