| NPI | 1649521436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN LSW0000007372) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AR 10161-C) |
| 1041C0700X Social Worker, Clinical (Licence: MS C9757) | |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2022-09-08 |