| NPI | 1114237807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 70958723502) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2021-01-12 |