| NPI | 1730319823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA cw023091) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA sw127124) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2023-06-16 |