| NPI | 1740735208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8977-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FM 6801099857) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801099857) | |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2020-03-05 |