| NPI | 1316172943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6763) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L6367) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2025-02-07 |