| NPI | 1649520198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-35358) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 35358) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2024-08-09 |