| NPI | 1306555214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 21445) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC200002201) |
| Enumeration Date | 2022-11-18 |
| Last Update Date | 2024-09-13 |