| NPI | 1679182893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C015332) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2022-10-09 |