| NPI | 1790728723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 2628) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 09625) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2024-05-28 |