| NPI | 1356695365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 119903) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 8474500-3506) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2024-05-07 |