| NPI | 1225456007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN 13314) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker Clinical (Licence: ME MC21839) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2023-09-01 |