| NPI | 1760401525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 4925843-3502) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2023-04-21 |