| NPI | 1235611054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NE 7271) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 11597) |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2018-08-29 |