| NPI | 1629196860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AR 1938-C) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MS C2646) |
| 1041C0700X Social Worker Clinical (Licence: TN LSW0000003116) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2024-02-07 |