| NPI | 1407323801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C014746) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P012916) |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2025-01-27 |