| NPI | 1578903944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 05534) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 8912) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2023-02-06 |