| NPI | 1205320603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904015854) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: AZ 0904015854) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2024-11-18 |