| NPI | 1174922355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-33966) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 16520) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2024-03-18 |