| NPI | 1184031759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ND 4997) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ND 4997) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2024-08-09 |