| NPI | 1669571196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TN 6051) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW8400) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2014-10-03 |