| NPI | 1508552605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-04-12 |