| NPI | 1053823294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ND 5172) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ND 5172) |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2018-07-10 |