| NPI | 1174091888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9764) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 131254) |
| Enumeration Date | 2018-11-12 |
| Last Update Date | 2021-08-17 |