| NPI | 1093147316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 7759-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 8951247-3501) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2020-01-10 |