| NPI | 1174971014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-38193) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LMSW-35746) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2023-10-09 |