| NPI | 1083989370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 19378) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P006630) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2021-09-16 |