| NPI | 1396089470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L6831) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2023-06-28 |