| NPI | 1598438491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 095400) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM C-12181) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2022-06-07 |