| NPI | 1801117882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-11749) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 082916-01) |
| 1041C0700X Social Worker, Clinical (Licence: OR L7021) | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2023-09-08 |