| NPI | 1780918268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW 30922) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-30922) |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2024-05-14 |