| NPI | 1790021897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 10047-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2022-10-12 |