| NPI | 1225644073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN 7569) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN 9755) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2021-03-01 |