| NPI | 1639622327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C011724) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC P010679) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2021-12-07 |