| NPI | 1629258744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4366) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 6866) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2024-04-16 |