| NPI | 1366060469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 10053-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 131888-121) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2022-12-12 |