| NPI | 1629765193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P021555) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 125479) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2024-12-16 |