| NPI | 1780148643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 11806627-3501) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2022-02-25 |