| NPI | 1770950016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 38756) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW34869) |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2022-12-23 |