| NPI | 1023621612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 9529) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: TN 14105) | |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2024-12-02 |