| NPI | 1487296851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 16753) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW16753) |
| 1041C0700X Social Worker, Clinical (Licence: MD 23565) | |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2020-10-13 |