| NPI | 1326504853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C014561) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P013145) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2022-10-31 |