| NPI | 1376734426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7399) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 4149) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2023-04-17 |