| NPI | 1790393510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: KS 11684) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 11684) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2022-12-14 |