| NPI | 1194349472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L14318) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN LSW000008234) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2024-06-24 |