| NPI | 1184477887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SWI.LW.61540207) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 113573) |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2024-04-10 |