| NPI | 1316513997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 11406) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MS C9703) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2021-09-24 |