| NPI | 1225656663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C015259) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC P014903) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2022-09-08 |