| NPI | 1477076677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 10806) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 3826) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2024-03-29 |