| NPI | 1326557455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-44861) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-36960) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2024-03-25 |