| NPI | 1609552264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 2454) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 1860) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2023-07-28 |