| NPI | 1598210882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C8888) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MS M8888) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2020-10-14 |