| NPI | 1235162132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ND 6240) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 5139730-3501) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-03-29 |