| NPI | 1104162122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 8233) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 008233) |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2020-04-13 |