| NPI | 1386098499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C10234) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 14708) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2022-09-01 |