| NPI | 1336924539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 06167) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2014041331) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2023-08-28 |