| NPI | 1578269858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 26300) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 26300) |
| 1041S0200X Social Worker, School (Licence: MD 26300) | |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2023-02-07 |