| NPI | 1104400639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 11770) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 11770) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2023-11-02 |