| NPI | 1679069454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 9934-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 7066-S) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2022-06-30 |