| NPI | 1699876177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61035815) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 070877-1) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-03-06 |