| NPI | 1992711386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN LSW4235) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MS C7174) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-12-16 |