| NPI | 1184917346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-33226) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LSW 29478) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2024-02-15 |