| NPI | 1639898919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: 1172) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS 1172) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2022-08-22 |