| NPI | 1134613342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM X-11319) |
| 1041C0700X Social Worker, Clinical (Licence: NC P010980) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2022-01-10 |