| NPI | 1578780219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 2187C-0923) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 6472) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2024-07-01 |