| NPI | 1982613220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005712) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW001246) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2014-06-11 |