| NPI | 1184121568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 10417) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 4208) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-06-29 |