| NPI | 1780010041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 113550) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-33260) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2022-07-21 |