| NPI | 1942309828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7833) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA IA 850) |
| 104100000X Social Worker (Licence: WI 7833) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2012-03-01 |