| NPI | 1730229147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TN 3974) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA csw004958) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2014-12-10 |