| NPI | 1649536004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NV 7543-C) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: UT 8141014-3501) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2021-06-21 |