| NPI | 1265874184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID 36531) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IA 33151) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2022-09-21 |