| NPI | 1376090498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SW13955) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL Isw9192) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2021-11-29 |