| NPI | 1043765548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 8428-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L8073) |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2019-07-01 |