| NPI | 1538623673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: 149.022905) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2024-08-07 |