| NPI | 1568970895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L14625) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LMSW-15780) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2024-04-15 |