| NPI | 1619351483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-37858) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 7753052-3501) |
| Enumeration Date | 2015-07-11 |
| Last Update Date | 2018-09-10 |