| NPI | 1376858241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-11825) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM M-10317) |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2021-07-20 |