| NPI | 1700424041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW42454) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID MSW-39263) |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2022-07-12 |