| NPI | 1073662557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AL 4115C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM B-05862) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2023-08-23 |