| NPI | 1275956880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7036) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-35711) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2022-12-28 |