| NPI | 1255656260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C010152) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904007351) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2022-07-21 |