| NPI | 1497317887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015223) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P014915) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2022-09-29 |