| NPI | 1639130339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C004699) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW94797) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW4891) | |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW004199) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-05-27 |