| NPI | 1821160219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 7591-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 127011-121) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2015-03-12 |