| NPI | 1265458079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WY 554) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SD 01099152) |
| 104100000X Social Worker (Licence: WY 252) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2024-07-02 |