| NPI | 1326655564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C011450) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 9512-123) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2023-10-06 |