| NPI | 1053642157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 05762) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MD 030437) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2024-02-12 |