| NPI | 1619702388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW009264) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2024-0934) |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-09-10 |