| NPI | 1346569746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6233) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C003108) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2023-07-07 |