| NPI | 1215113808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 1022200) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 1022200) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2020-09-17 |