| NPI | 1487053674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7270) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW17965) |
| 1041C0700X Social Worker, Clinical (Licence: KY 7108) | |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2022-08-26 |