| NPI | 1366037590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C014062) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P013606) |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2024-08-21 |