| NPI | 1164137089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 13422) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 5952) |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2023-11-05 |