| NPI | 1497295620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-40176) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID lmsw-36483) |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2024-03-07 |