| NPI | 1053702548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM M-08056) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM M-08056) |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2024-06-25 |