| NPI | 1528452398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10448871-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LSW-34510) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2019-08-22 |