| NPI | 1144600966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AL 4054C) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: AL 3725G) |
| Enumeration Date | 2015-06-06 |
| Last Update Date | 2023-11-27 |