| NPI | 1245558576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NC C008932) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC C008932) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2024-07-15 |