| NPI | 1487154589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-41070) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LMSW-38426) |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2021-07-21 |