| NPI | 1538661038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 17058) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 12371) |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2024-10-31 |