| NPI | 1134868649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ID 42215) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 108183) |
| 1041C0700X Social Worker, Clinical (Licence: CA 108183) | |
| 1041C0700X Social Worker, Clinical (Licence: ID 42215) | |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2022-06-02 |