| NPI | 1568796142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AL 3853C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AL 2117G) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2021-02-14 |