| NPI | 1912208646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA csw005312) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 005879) |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2018-11-17 |