| NPI | 1639210503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005774) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW001814) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2011-08-09 |