| NPI | 1659095933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 5818) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C015026) |
| 1041C0700X Social Worker, Clinical (Licence: KY 257274) | |
| 1041C0700X Social Worker, Clinical (Licence: IN 34008868A) | |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2023-08-30 |