| NPI | 1225373137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-40292) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 171560202) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2022-08-28 |