| NPI | 1154843654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C012391) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P011717) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2024-02-29 |