| NPI | 1669032702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 18914) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2020-11-24 |