| NPI | 1063755635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-40120) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LMSW-32675) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2020-11-03 |