| NPI | 1386263721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 11858) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 5169) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2024-01-30 |