| NPI | 1407155138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-33433) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 10891360-3501) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2022-04-13 |