| NPI | 1598086480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW32485) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW 30531) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2021-04-21 |