| NPI | 1043729965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C017506) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-5121) |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2024-09-17 |