| NPI | 1457966764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 39918) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID 39918) |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2020-09-17 |