| NPI | 1154772622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 05805) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2019-07-23 |