| NPI | 1609285212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 12753) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: LA 12753) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2021-03-12 |