| NPI | 1942686175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006235) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW006645) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2018-06-26 |