| NPI | 1740641489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ 18888) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: VA 0904015917) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2024-05-14 |