| NPI | 1578229787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L11800) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR a12687) |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2024-06-26 |