| NPI | 1962776559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW005657) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 10235) |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2016-12-13 |