| NPI | 1174827489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 19575) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 1078813-3501) |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2025-01-03 |