| NPI | 1063109577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: SD 6347) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 8635-M) |
| 1041C0700X Social Worker, Clinical (Licence: CA 112585) | |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2023-04-24 |