| NPI | 1790299428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 12861) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904009680) |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2020-09-23 |