| NPI | 1720555410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 14583) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 226608) |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2022-04-26 |