| NPI | 1356676852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904010254) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OK 8806) |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2022-10-25 |