| NPI | 1629366968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7935) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 17719) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2024-01-29 |