| NPI | 1275107286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P013673) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: C014524) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2021-12-04 |