| NPI | 1023354214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8307) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 128577-121) |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2024-09-20 |