| NPI | 1205945714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 8762) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C005204) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-05-12 |