| NPI | 1083397319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV IC-2299) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 9171-M) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-10-03 |