| NPI | 1053577361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 7914-123) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 14182) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2024-04-22 |