| NPI | 1730407859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA lw61534697) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 364759-3501) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2024-06-21 |