| NPI | 1558989285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P012875) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L12747) |
| Enumeration Date | 2020-07-09 |
| Last Update Date | 2021-10-15 |