| NPI | 1770003691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 8627-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 7510-s) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2022-11-18 |