| NPI | 1134782774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 132922) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2014033179) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2019-04-18 |