| NPI | 1184647562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NV 10684C) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL SW2796) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-07-12 |