| NPI | 1457915688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 9163814-3501) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2022-12-15 |