| NPI | 1659669455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID LCSW-34027) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OR L6128) |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2023-06-19 |