| NPI | 1639502982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID LCSW-37176) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-33074) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2024-02-16 |