| NPI | 1104476597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2023-05-05 |