| NPI | 1023451739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P015508) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P011122) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2022-05-18 |