| NPI | 1144683699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C009953) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2023-01-03 |