| NPI | 1073294005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 18628) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 7585) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2023-07-31 |